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Peer-reviewedCC BY-NC-ND 4.0BMC Emergency Medicine

Implementation and early operational evaluation of a National Pediatric Triage System in a Referral Hospital in Beira, Mozambique: a one-year implementation study

  • Irene Avagnina1
  • Marco Frison1
  • Amir H. A. Seni2,3
  • Nércio Liasse2
  • Ahivaldino Z. M. Zita4
  • Nilza I. L. W. Lee4
  • Muhammad Y. H. Salgado2
  • Sheila J. E. O. Meira5
  • Euridxe Barbosa6
  • Giovanni Putoto7
  • Liviana Da Dalt7
  • Veronica Casotto8
1 more authors
  • Silvia Bressan8,9
9 affiliations
  1. 1Doctors with Africa CUAMM Mozambique, Av. Mártires da Revolução N° 654, Macuti, Beira, Mozambique
  2. 2Department of Pediatrics, Beira Central Hospital, Beira, Mozambique
  3. 3Department of Research, Faculty of Health Sciences, Catholic University of Mozambique, Beira, Mozambique
  4. 4Beira General Hospital, Beira, Mozambique
  5. 5Medical Emergency Service of Mozambique, Ministry of Health, Maputo, Mozambique
  6. 6Military Hospital of Beira, Beira, Mozambique
  7. 7Doctors with Africa CUAMM, Padua, Italy
  8. 8Department of Women’s and Children’s Health, University of Padua, Padua, Italy
  9. 9Pediatric Emergency Department, University Hospital of Padua, Padua, Italy
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Abstract

Background: Pediatric mortality in low- and middle-income countries (LMICs) remains largely attributable to time-sensitive and treatable conditions. Structured triage systems are essential to prioritize care and reduce preventable deaths, yet implementation evidence in LMIC referral hospitals is limited.

Objectives: This study aimed to describe the implementation of a newly developed national triage tool in the Pediatric Emergency Department (PED) in a referral hospital in Beira, Mozambique, and evaluate its early operational integration using implementation outcomes over the first year of practice.

Methods: We conducted a multi-component implementation of the triage tool between October 2023 and January 2026. A retrospective observational analysis evaluated implementation outcomes between April 2024 and March 2025.

Results: Of 28,469 pediatric visits, 76.3% underwent documented triage. Uptake varied over time, with lower adherence on weekends than weekdays (62.8% vs 80.1%), during night versus morning shifts (70.0% vs 90.3%), in September 2024 (56.6%) and March 2025 (59.1%) coinciding with understaffed shifts and workforce instability. Adherence to data recording improved over time, from an average of 36.7% missing data in April 2024 to 17% in March 2025. Among triaged patients, 83% were classified as non-urgent and 17% as urgent. Overall, 86.9% were discharged, 12.3% hospitalized, 0.7% required intensive care admission, and 0.1% died in the PED.

Conclusions: Pediatric triage system implementation was feasible in a resource-constrained referral hospital, although sustainability was mainly influenced by workforce instability. Dedicated training, workflow redesign, institutional ownership, and continuous monitoring emerged as key implementation strategies that may inform future scale-up across similar LMIC settings.

Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1186/s12873-026-01719-0.

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Cite

BibTeXRIS
BibTeX
@article{avagnina2026implementation,
  title = {{Implementation and early operational evaluation of a National Pediatric Triage System in a Referral Hospital in Beira, Mozambique: a one-year implementation study}},
  author = {Irene Avagnina and Marco Frison and Amir H. A. Seni and Nércio Liasse and Ahivaldino Z. M. Zita and Nilza I. L. W. Lee and Muhammad Y. H. Salgado and Sheila J. E. O. Meira and Euridxe Barbosa and Giovanni Putoto and Liviana Da Dalt and Veronica Casotto and Silvia Bressan},
  journal = {BMC Emergency Medicine},
  year = {2026},
  month = aug,
  doi = {10.1186/s12873-026-01719-0},
  url = {https://doi.org/10.1186/s12873-026-01719-0},
  note = {CC BY-NC-ND 4.0},
}
RIS
TY  - JOUR
TI  - Implementation and early operational evaluation of a National Pediatric Triage System in a Referral Hospital in Beira, Mozambique: a one-year implementation study
AU  - Irene Avagnina
AU  - Marco Frison
AU  - Amir H. A. Seni
AU  - Nércio Liasse
AU  - Ahivaldino Z. M. Zita
AU  - Nilza I. L. W. Lee
AU  - Muhammad Y. H. Salgado
AU  - Sheila J. E. O. Meira
AU  - Euridxe Barbosa
AU  - Giovanni Putoto
AU  - Liviana Da Dalt
AU  - Veronica Casotto
AU  - Silvia Bressan
PY  - 2026
DA  - 2026/08/11
JO  - BMC Emergency Medicine
DO  - 10.1186/s12873-026-01719-0
UR  - https://doi.org/10.1186/s12873-026-01719-0
AB  - Background: Pediatric mortality in low- and middle-income countries (LMICs) remains largely attributable to time-sensitive and treatable conditions. Structured triage systems are essential to prioritize care and reduce preventable deaths, yet implementation evidence in LMIC referral hospitals is limited.  Objectives: This study aimed to describe the implementation of a newly developed national triage tool in the Pediatric Emergency Department (PED) in a referral hospital in Beira, Mozambique, and evaluate its early operational integration using implementation outcomes over the first year of practice.  Methods: We conducted a multi-component implementation of the triage tool between October 2023 and January 2026. A retrospective observational analysis evaluated implementation outcomes between April 2024 and March 2025.  Results: Of 28,469 pediatric visits, 76.3% underwent documented triage. Uptake varied over time, with lower adherence on weekends than weekdays (62.8% vs 80.1%), during night versus morning shifts (70.0% vs 90.3%), in September 2024 (56.6%) and March 2025 (59.1%) coinciding with understaffed shifts and workforce instability. Adherence to data recording improved over time, from an average of 36.7% missing data in April 2024 to 17% in March 2025. Among triaged patients, 83% were classified as non-urgent and 17% as urgent. Overall, 86.9% were discharged, 12.3% hospitalized, 0.7% required intensive care admission, and 0.1% died in the PED.  Conclusions: Pediatric triage system implementation was feasible in a resource-constrained referral hospital, although sustainability was mainly influenced by workforce instability. Dedicated training, workflow redesign, institutional ownership, and continuous monitoring emerged as key implementation strategies that may inform future scale-up across similar LMIC settings.  Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1186/s12873-026-01719-0.
SN  - 1471-227X
ER  -